Diabetes Research
| January again and the year begins with reminders to schedule all of those medical appointments that you need to keep your health glowing. That means making sure that you call your internist, endocrinologist, cardiologist, and if applicable, urologist, ophthalmologist, neurologist, or ob-gyn. At the same time please don’t forget the general dentist, periodontitus, and podiatrist. It starts off the year with all of the knowledge you will need to lead the healthiest and fullest lives possible. Oh, and by the way, while you are on the phone, please call your closest gym and friends to go daily to help keep those blood glucose levels stable while strengthening muscles and internal organs. OK, you’ve done all of that so you’re ready to sit back and read the latest in research that we bring you each month. We wish you and yours a happy and healthy new year. |
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As always, we start with headlines and then go on to our abstracts which this month will address diabetes screening in primary care and then the glycemic curability of
rosiglitazone, metformin, or glyburide monotherapy.
We found many articles for the headlines section this month so let’s get to it. Lest you were not aware if the fact, obesity is a growing problem with people with type 1 diabetes. The National Kidney Foundation on Dec. 6th, that people for people with type 1 diabetes obesity is associated with a higher incidence of kidney disease. The research at the University of Washington in Seattle by Dr. Ian H. de Boer et al looked at waist circumference (central obesity) and kidney disease risk. The study found that the larger the patients’ waist measurements, the greater the risk for kidney disease. In fact for every 4-inch increase in waist circumference, there was a 34% increased risk of micoalbuminuria, an important sign of kidney disease. This held true even after researchers adjusted for other factors, including intensive insulin therapy. Now you know why we include articles on Exercise each month. Please read them and after seeing your physician for the OK, begin to get your weight under control. The American Diabetes Association in November reported that scientists in the US and New Zealand have calculated that in addition to the 960,000 diabetes deaths worldwide each year, raised blood sugar levels are linked to 1.5 million deaths from heart disease and 700,000 from strokes. “A lot of people are dying as a result of their blood glucose being elevated even though many may well be below the clinical threshold of what we call diabetes," Dr. Majid Ezzati, of the Harvard School of Public Health said in an interview. Just to make sure that this was a universal problem, the researchers examined data from heart disease and stroke patients from 52 counties around the world. All of this was published in The Lancet medical journal if you want to read more. The put the figure of 2.4 million deaths attributed to high blood glucose levels. We all know that some people put off treating higher than usual blood glucose levels for many reasons. Perhaps they need to re-examine this. Last month we earned you about counterfeit blood glucose test strips. The original news gave a list of numbers on the packages. Here are some more.
The global diabetes epidemic is projects to affect 7 percent of the world’s population by 2025 as developing countries embrace the bad habits associated with affluence, medical experts reported at the World Diabetes Congress in Cape Town, the first week of December. Experts say diabetes kills as many people as HIV/AIDS and is emerging as one of the chief public health challenges of the 21st century. The geography of type 2 diabetes is now spreading quickest in the Eastern Mediterranean and Middle East. The United Arab Emirates and Saudi Arabia, for example, have diabetes prevalence rates of between 16 and 20 percent of their adult populations. The small South Pacific nation of Nauru has the world’s highest prevalence of diabetes at more than 30 while India and China have the greatest numbers of diabetics at about 40 million apiece. South America is expecting to see rates double while Africa expects an 80% increase and the Indian sub-continent a 56% increase. If you thought that headline was sobering, keep reading. We know that as parents our job is to protect our children. One way to protect these precious young people is to make sure that we know the family’s risk factors for type 2 diabetes and then do some things to prevent our children form developing this disease. This means eating more healthfully and making sure our children exercise or as we used to say, “play" outside. Dr. Francine Kaufman, professor of Pediatrics at the University of Southern California medical school shared at the World Diabetes Congress in Cape Town. An estimated 70,000 children under the age of 15 develop type 1 diabetes every years, while type 2 is also affecting children as young as 8 in both developing and developed countries. Japan saw the prevalence of type 2 diabetes among junior high school students almost double to 14 percent, making it more common than type 1, while in some parts of the United States type 2 diabetes accounts for up to 45 percent of newly-diagnosed cases. To make matters worse, Henk-Jan Aanstoot, a pediatric diabetes specialist from Rotterdam spoke of the risk factors for untreated diabetes in children which included cardiovascular events as well as kidney disease, blindness and nerve damage. The epidemic of diabetes has continued to escalate. It is so pervasive that doctors are currently finding patients who suffer from both type 1 and 2 diabetes—a condition known as “double diabetes" or “hybrid diabetes". “It’s mostly people who have type 1 diabetes who become overweight and show the profile of a type 2, with obesity hypertension," said Dr. Stewart Weiss, an assistant clinical professor of Medicine at New York University School pf New York City. Doctors are now seeing strong indications that double diabetes is a growing phenomenon. For instance, recent statistics suggest that as many as 30 percent of newly diagnosed cases among children involve youngsters with both type 1 and 2 diabetes. Double-diabetes takes the suffering cause by the disease a step further, and complicated efforts to treat it. Frequently doctors see these children as type 1 diabetes that do not have a good understanding of how to eat and are taking insulin to cover what they normally eat—thus the normal gain in weight that occurs when insulin is started to treat diabetes continues as the children eat what they want and when to eat. The obesity epidemic has become all inclusive! Time for those all important abstracts, Pediatrics, Vol. 118, NO. 5, Nov.2006, 1888-1895 includes an article titled Diabetes Mellitus Screening in Pediatric Primary Care by Shikha G. Anand, MD, MPH et al. The goal was to determine the rates of diabetes screening and the prevalence of screening abnormalities in overweight and non-overweight individuals in an urban primary care clinic. This is a retrospective chart review. Deidentified data for patients who were ages 10 to 19 years of age and had =BMI measurement between September 1, 2002, and September 1, 2004 were extracted from the hospital electronic health record. A total of 7710 patients met the study criteria. Patients were 73.9% black or Hispanic and 47.0% female; 42.0% of children exceeded normal weight, with 18.2% at risk for overweight and 23.8% overweight. Based on BMI, family history, and race, 8.7% of patients met American Diabetes Association criteria for type 2 diabetes mellitus screening, and 2452 screening tests were performed for 1642 patients. Female gender, older age group, and family history of diabetes were associated with screening. Increased BMI percentile was associated with screening, exhibiting a dos-response relationship. Screening rates were significantly higher (45.4% vs.19.9%) for patients who met the ADA criteria; however less than half of adolescents who should have been screened were screened. Abnormal glucose metabolism was seen for 9.2 of patients screened. The researchers concluded that the research shows that, although pediatricians are screening for diabetes mellitus, screening is not being conducted according to the ADA consensus statements. Point-of-care delivery of consensus recommendations could increase provider awareness of current recommendations, possibly improving rates of systemic screening and subsequent identification of children with laboratory evidence of abnormal glucose metabolism. The New England Journal of Medicine 2006;355:2427-43 has an article to read and share with your physician if you take any of these medications. Glycemic Durability of Rosiglitazone. Metformin or Glyburide Monotherapy is written by Steven E. Kahn, M.B., Ch.B et al for the ADOPT Study Group. The efficacy of thiazolidinediones, as compared with other oral glucose-lowering medications, in maintaining long-term glycemic control in type diabetes is not known. The researchers evaluated rosiglitazone, metformin, and glyburide as initial treatment for recently diagnosed type 2 diabetics in a double-blind, randomized, controlled clinical trial involving 4360 patients. The patients were treated for a median of 4.0 years. The primary outcome was the time of monotherapy failure, which was defined as a confirmed level of fasting plasma glucose of more than 180 mg per deciliter for rosiglitazone, as compared with metformin or glyburide. Pre-specified secondary outcomes were levels of fasting plasma glucose and glycated hemoglobin, insulin sensitivity, and ß-cell function. Kaplan-Meier analysis showed a cumulative incidence of monotherapy failure at 5 years of 15% with rosiglitazone, 21% with metformin, and 34% with glyburide. This represents a risk reduction of 32% for rosiglitazone, as compared with metformin, and 63%, as compared with glyburide. Glyburide was associated with a lower risk of cardiovascular events (including congestive heart failure) than was rosiglitazone. Rosiglitazone was associated with more weight gain and edema than either metformin of glyburide but with fewer gastrointestinal events than metformin and less hypoglycemia than glyburide. The researchers concluded that the potential risks and benefits, the profile of adverse events, and the costs of theses three drugs should be considered to help inform the choice of pharmacotherapy for patients with type 2 diabetes. BSP |
